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          <h1 class="post-title" itemprop="name headline">021.2019新锐读会 课程笔记《粘接牙科学的基本原理》04</h1>
        

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        <p>第二节 两部粘接体系的粘结原理<br>1.市场相关产品<br>SE-Bond，美塑，Keer XTR<br>2.各组分与牙体的粘接原理<br>a.成分组成<br>共聚有机酸（本质表面调节剂），使用前应摇匀。<br>双性树脂如HEMA<br>溶剂：水（湿润及保持液态），乙醇，粘接功能单体<br>b.pH值<br>10%磷酸    0.8<br>32%磷酸    0.1<br>37%磷酸    0.1<br>有机弱酸，pH值大多为1-2。<br>c.与釉质作用机制<br>对釉质很弱，最好用全酸蚀处理牙釉质，即选择性酸蚀。<br>d.与本质作用机制<br>底漆<br>使玷污层改性，暴露1微米左右胶原纤维，部分溶解及改性为混合层形成基础，牙本质小管未开放，管周牙本质碧化学粘接。酸蚀与底漆同步深度保持一致。<br>磷酸盐/磷酸酯及其它酸性单体的作用——与本质中的矿物质产生化学结合。<br>如MDP与钙结合。<br>粘接剂<br>原理及成分同3步全酸相似，将改性后的亲水酸性界面变成混合层且疏水偏中性界面。<br>酸与底漆同步深度，几乎不存在酸蚀与深度不同步，导致敏感的问题。<br>e.优缺点及适应症<br>优点：术后敏感性小。<br>缺点：需单独酸蚀釉质。<br>适应症：直接修复，不建议用作间接修复（成膜厚度偏厚）。<br>3.操作流程<br>1.35%磷酸酸蚀釉质30s，冲洗干燥。<br>2.2%洗必泰消毒窝洞30s。（解决酸蚀与处理不同步的问题，可省略）<br>3.干燥釉质及本质。<br>4.蘸取新鲜Primer（应该垂直滴到瓶皿中，不要用毛刷去沾，更不要去沾瓶口剩余的。）<br>5.反复涂布15s（本质釉质都涂）<br>6.重复第五步，即涂2遍。<br>7.中等气流1cm处干燥10s（使水，乙醇等挥发掉）<br>8.表面出现光亮无波动为标准。<br>9.若出现灰白重新涂布。<br>10.涂布粘接剂20s，轻吹10s（使粘接剂散匀，不用重吹）<br>11.光固化20-40秒<br>第三节 通用型粘接体系的粘接原理<br>1.通用型粘接剂的特点<br>①类似于自酸蚀粘接剂不用酸蚀粘接底层适合粘接牙本质，可不考虑牙本质湿度。<br>②粘接不完全取决于混合层，10-MDP与牙本质可与牙本质产生化学结合。<br>③10-MDP与牙本质中钙离子生成MDP-钙盐是一种稳定水解稳态盐。<br>④MDP-Ca盐可以防止粘接层被降解。<br>2.临床常用通用型粘接剂的种类及组成<br>SBU, All-Bond Universal<br>pH都大于2，温和型。<br>关于Vitrebond Copolymer的理解<br>①类似于玻璃离子水门汀Vitrebond中相同的聚烯酸共聚体。<br>②可促进与羟磷灰石中的钙离子结合。<br>③有人认为这些共聚体会与10-MDP竞争结合羟磷灰石，从而减弱这些粘接剂的粘接强度。<br>④除此之外这些单体的分子量高，聚合中难以相互靠近，单体转化率降低。<br>3.粘接原理<br>“粘附脱钙”与牙本质中的钙形成MDP-Ca<br>MDP-Ca盐在粘接界面形成自组合纳米层积。<br>通用粘接剂对釉质和本质的处理理论循证<br>①用于釉质粘接时，仍然建议在涂布粘接剂之前进行磷酸酸蚀以获得最好的粘接效果。<br>②尽管10-MDP单体可以羟磷灰石结合，但是牙釉质中的羟磷灰石的大小和结构都不倾向与其结合。<br>③不建议磷酸酸蚀牙本质后采用通用粘接剂，因为钙离子流失会损害羟磷灰石与酸性单体之间的化学结合。<br>4.存在硅烷的必要性<br>氢氟酸处理过的玻璃基陶瓷界面涂布硅烷后偶联剂的反应机制<br>R-Si-OH（硅烷） + HO-Si-瓷（HF处理过的玻璃陶瓷） – R-Si-Si-瓷（硅氧烷，疏水） + 水<br>缩合反应<br>通用粘接剂中硅烷未起到作用的理论循证<br>①硅烷在通用粘接剂体系中未起作用的原因可能是Bis-GMA与其它树脂混合在一起阻止了凝结反应<br>②凝结发生在硅烷的硅醇基团（ -Si-OH-）及陶瓷的OH-基团，解离水分子形成稳定的硅氧烷(Si-O-Si)粘接形式<br>③水分子的解离对于凝结反应的持续发生很重要，且在其它树脂存在的情况下会阻止此反应的发生，会减慢水分子的蒸发(Le Chatelier的理论）<br>④有研究报道称经热循环后，SBU对酸蚀的二硅酸锂的粘接强度降低&gt;50%。<br>因此不能宣扬用粘接剂中的硅烷代替单独的硅烷处理。<br>5.流程<br>①35%磷酸酸蚀牙釉质30s<br>②彻底清洗磷酸干燥<br>③2%洗必泰消毒本质30s（可省略）<br>④强吸干燥窝洞2s（不见明显水分，不可过干，因为含的水，HEMA及乙醇均较少）<br>⑤滴1-2滴到平皿<br>⑥毛刷涂布预备体表面10-15s<br>⑦重复涂一遍，两遍之间不固化。<br>⑧气枪由远到近气流由弱到强吹10s，标准：预备体表面无流动粘接剂，表面可见均匀光泽外观。<br>⑨光固化20s<br>即可用于直接修复，也可用于间接修复。<br>第四章 粘接系统与复合材料<br>第一节 粘接系统的聚合与氧阻聚层<br>1.粘接剂的聚合过程<br>第一步，引发<br>引发剂吸收光能产生自由基。<br>第二步，增长<br>自由基与树脂单体分子结合，形成长链。<br>第三步，终止<br>单体消耗完后，反应终止。<br>2.氧阻聚层的形成<br>粘接剂有一面与空气直接接触，空气中的氧气会与自由基结合，结合端被氧先结合而无法聚合。这就是氧阻聚层，一般约2-6μm。<br>第二节 氧阻聚层的特性<br>取决于粘接剂的pH值及成分<br>第三节 复合材料的类别及聚合<br>1.复合材料的类别及组成<br>自由基的产生是树脂聚合的开始，凡是干扰自由基产生的因素都会干扰树脂聚合。<br>光固化树脂及水门汀（直接修复或粘贴面）<br>引发剂，CQ（樟脑醌）吸收光能变成激发态的樟脑醌，与重引发剂（胺类）反应形成中间产物，中间产物不稳定，分解产生自由基。自由基的产生只与光和引发剂有关，与其它因素无关。<br>自固化及双固化树脂水门汀（间接修复嵌体或冠）<br>BPO（过氧基苯甲酰，催化剂）与叔胺P-TID反应，生成中间分子，中间分子不稳定，分解产生自由基。自由基的产生只与催化剂和被催化的底物有关。<br>双固化树脂水门汀<br>有两套引发体系。</p>
<p><strong>个人总结：讲了第六代和第八代粘接剂的问题，第六代酸蚀剂和底漆为一瓶，粘接剂为一瓶，酸为弱酸，对于牙釉质效果差，最好选择性酸蚀。使用时，底漆要摇匀，涂两遍。用于直接修复，不用于间接修复，因为成膜厚度较大。第八代所有成分都在一瓶里，釉质也要单独酸蚀，主要含有MDP，能与牙本质中的钙形成MDP-Ca盐，有化学结合的作用。其里面含有的硅烷并不能替代单独的硅烷。也是要涂两遍。可以用于间接修复和直接修复。这两代粘接剂底漆和酸蚀剂的进入深度是一致的，不容易像第四代那样产生术后敏感的问题。粘接剂，树脂的聚合主要靠其中的引发剂引发生成自由基，自由基与树脂单体结合形成长链。因此生成自由基是关键。氧与树脂中的自由基结合形成氧阻聚层会阻止树脂聚合，主要取决于pH值和成分。引发剂的不同形成了光固化（樟脑醌引发），化学固化（BPO引发）还有双固化。后两者都是双组份的。平时使用的时候还是有一些问题。</strong></p>
<p>我发文章的三个地方，欢迎大家在朋友圈等地方分享，欢迎点“在看”。<br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的CSDN博客地址：<a target="_blank" rel="noopener" href="https://blog.csdn.net/zwdnet">https://blog.csdn.net/zwdnet</a><br>我的微信个人订阅号：赵瑜敏的口腔医学学习园地</p>
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